Diseases of Malabsorption

Question 1

What is celiac disease?

Answer 1

A digestive disease that damages the small intestine and interferes with absorption of nutrients from food

Question 2

What can people with celiac disease not tolerate?

Answer 2

Gluten: a protein in wheat rye and barley

Question 3

What occurs when celiac patients ingest gluten?

Answer 3

Their immune system destroy villi in the SI

Question 4

What is a malabsorption disease?

Answer 4

Nutrients are not properly absorbed

Question 5

What are the general symptoms of celiac disease in children and adults?

Answer 5

Children: digestive symptoms
Adults: less likely to have digestive symptoms

Question 6

What is tested for in the blood for those with celiac disease?

Answer 6

Anti-tissue transglutaminase antibodies (tTGA)

Anti-endomysium antibodies (EMA)

Question 7

If blood tests and symptoms suggest celiac disease what is done next?

Answer 7

Intestinal biopsy

Question 8

What antibiotic controls the rash symptoms of dermatitis herpetiformis?

Answer 8

Dapsone

Question 9

What is the only treatment for celiac disease?

Answer 9

A gluten free diet

Question 10

What is refractory celiac disease?

Answer 10

When a patient has damaged unrepairable small intestines and do not absorb nutrients

Question 11

Without treatment, what can people with celiac disease develop?

Answer 11

Osteoporosis
Anemia
Cancer

Question 12

What is congenital sucrose-isomaltase deficiency?

Answer 12

The inability to break down sugars sucrose and maltose

Question 13

What type of sugars are sucrose and maltose and where are they found respectively?

Answer 13

Disaccharides
Sucrose: fruits (glucose and fructose)
Maltose: grains (2 glucose)

Question 14

When does sucrose-isomaltase deficiency become apparent?

Answer 14

When a child is weaned and beginning to eat fruit juices and grains

Question 15

What is the mutation in SI deficiency?

Answer 15

SI gene

Question 16

What is the inheritance pattern for SI deficiency?

Answer 16

Autosomal recessive

Question 17

What type of disease is Crohn’s disease?

Answer 17

Inflammatory bowel disease

Question 18

What does Crohn’s disease typically affect?

Answer 18

Ileum and beginning of colon

Question 19

General symptoms of Crohn’s disease?

Answer 19

Diarrhea
Rectal bleeding
Urgent BM

Question 20

How does Crohn’s cause inflammation?

Answer 20

Immune attack against healthy bacteria

Question 21

What is ulcerative colitis?

Answer 21

Lining of the colon becomes inflamed and develops tiny ulcers producing pus and mucous

Question 22

What causes the symptoms of ulcerative colitis?

Answer 22

WBC mounting attack against food, bacteria causing inflammation in the lining of the intestines

Question 23

Major difference between Crohn’s and ulcerative colitis?

Answer 23

Crohn’s: can affect any part of intestines and any layer of it
Ulcerative colitis: only affects lining of the colon

Question 24

Signs and symptoms of ulcerative colitis?

Answer 24

Loose urgent BM
Bloody stool
Diarrhea

Question 25

Tests for Crohn's:

Answer 25

Blood and stool X-rays of upper and lower GI with barium Endoscopy and biopsy

Question 26

What does medication do treat Crohn's disease?

Answer 26

Suppress immune system's abnormal inflammatory response

Question 27

What are 5 drugs that are to treat Crohn's?

Answer 27

``` Aminosalicylates (5-ASA) Antibiotics Biologic therapies Corticosteroids Immunomodulators ```

Question 28

What is Hartnup disorder?

Answer 28

Inherited metabolic condition that involves the transport of certain AAs in the SI and kidneys

Question 29

Symptoms of Hartnup?

Answer 29

``` Mood change Nervous system problems Skin rash when exposed to sunlight Short stature Uncoordinated movements ```

Question 30

Tests for Hartnup?

Answer 30

Urine test that has high levels of neutral AA and normal levels of other AA

Question 31

Gene testing for Hartnup disease?

Answer 31

SLC6A19

Question 32

Hartnup disease treatments?

Answer 32

Avoid sunlight High-protein diet Supplements of nicotinamide Antidepressant or mood stabilizers

Question 33

Complications of Hartnup?

Answer 33

Changes in skin color that are permanent

Question 34

What does SLC6A19 code for?

Answer 34

A sodium-dependent and chloride-independent neutral amino acid transporter

Question 35

Where is SLC6A19 found?

Answer 35

5p15.33

Question 36

How many mutations in SLC6A19 can cause Hartnup disorders?

Answer 36

Six

Question 37

Four phases of nutrient absorption:

Answer 37

Intraluminal Terminal Transepithelial Lymphatic transport of absorbed lipids

Question 38

Intraluminal digestion:

Answer 38

Proteins, carbs, fat broken down into forms able to be absorbed

Question 39

Terminal digestion:

Answer 39

Hydrolysis of carbs and peptides by disaccharidases and peptidases in the brush border

Question 40

Transepithelial digestion:

Answer 40

Nutrients, fluids, electrolytes transported across and processed within SI epithelium

Question 41

Skin disease caused by celiac disease:

Answer 41

Dermatitis herpetiformis

Question 42

Secretory diarrhea:

Answer 42

Isotonic stool and persists during fasting

Question 43

Osmotic diarrhea:

Answer 43

Lactase deficiency, excessive osmotic forces; diarrhea fluid more than 50 mOsm more concentrated than plasma, stops with fasting

Question 44

Malabsorptive diarrhea:

Answer 44

Associated with steatorrhea; relieved by fasting

Question 45

Exudative diarrhea:

Answer 45

Inflammatory disease purulent bloody stools that continue during fasting

Question 46

Disease producing component in Celiac disease:

Answer 46

Gliadin

Question 47

What does Gliadin induce?

Answer 47

IL-15

Question 48

What does IL-15 trigger?

Answer 48

Activation and proliferation of CD8+ intraepithelial lymphocytes

Question 49

What do the CD8+ intraepithelial lymphocytes express?

Answer 49

NKG2D (receptor for MIC-A)

Question 50

What occurs to lymphocytes that express MIC-A?

Answer 50

They are attacked by NKG2D-expressing intraepithelial lymphocytes

Question 51

What occurs once the enterocytes expressing MIC-A are damaged?

Answer 51

Gliadin peptides are able to get into the lamina propria and are deaminated by tissue transglutaminase

Question 52

When do cells produce MIC-A?

Answer 52

When they are stressed

Question 53

What do Gliadin peptides cause once inside the lamina propria?

Answer 53

Interact with HLA-DQ2 or HLA-DQ8 stimulating CD4+ T cells to produce cytokines contributing to tissue damage

Question 54

What HLA do all people with celiac carry?

Answer 54

Class II HLA-DQ2 or HLA-HQ8